ANATOMICAL FACTORS ASSOCIATED WITH OVERUSE SPORTS INJURIES

Overuse injuries develop when repetitive stress to bone and musculoten dinous structures damages tissue at a greater rate than that at which the body can repair itself. A combination of extrinsic factors, such a s training errors and environmental factors, and intrinsic or anatomic al factors, such as bony alignment of the extremities, flexibility def icits and ligamentous laxity, predispose athletes to develop overuse i njuries. Malalignment of the lower extremity, including excess femoral anteversion, increased Q angle, lateral tibial torsion, tibia vara, g enu varum or valgum, subtalar varus and excessive pronation are freque ntly cited as predisposing to knee extensor mechanism overuse injuries , These and other forms of malalignment have also been implicated in i liotibial band syndrome, medial tibial stress syndrome, lower extremit y stress fractures and plantar fasciitis, Muscle inflexibility aggrava tes and predisposes to the development oi a variety of overuse injurie s, especially those occurring in children and adolescents, including t he traction apophysitises, Flexibility deficits may be improved by an appropriate stretching programme. Unfortunately, lower extremity malal ignment is less amenable to intervention. Orthotics are often prescrib ed to improve lower extremity alignment, However, studies have not sho wn that orthotics have any effect on knee alignment and, while they ca n alter subtalar joint alignment, the clinical benefit of this remains unclear. Awareness of anatomical factors chat may predispose to overu se injuries allows the clinician to develop individual prehabilitation programmes designed to decrease the risk of overuse injury. In additi on, the clinician can advise the athlete on the importance of avoiding extrinsic factors that may also predispose to overuse injury.